Healthcare Provider Details

I. General information

NPI: 1407805419
Provider Name (Legal Business Name): AUSTIN NEUROLOGICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST BUILDING F 1
AUSTIN TX
78705-1121
US

IV. Provider business mailing address

711 WEST 38TH STREET BUILDING F1
AUSTIN TX
78705-1181
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-6121
  • Fax: 512-452-9171
Mailing address:
  • Phone: 512-458-6121
  • Fax: 512-452-9171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE THOMAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 512-637-5894